164315 09/30/2008 t, CITY OF CARMEL, INDIANA VENDOR: T361907 Page 1 of 1
ONE CIVIC SQUARE TYLER LACOSSE CHECK AMOUNT: $20.00
CARMEL, INDIANA 46032 345 ENDICOTT ST
APT 3203 CHECK NUMBER: 164315
CARMEL IN 46032
CHECK DATE: 9/3012008
DEPAR ACCOUNT PO N UMBER INVOICE NUMBE A DESC
1047 4358400 20.00 REFUNDS.AWARDS TNDE
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PASS REFUND RECEIPT
Receipt 178939
Payment Date: 08/19/2008 RE�
Household 21398
Home Phone: (815)592 -8932 SEP 200$
Work Phone:
BY:
1
TYLER LACO Monon Center
'All"11�
3 CrY,1l c�f Carmel IN 46032
X0 3 2 ,)-3 Phone: (317)848 -7275
CA r-he- u 3 Z Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 20.00
Pass Holder: Tyler Lacosse Fees Tax Discount Prev Paid Cur Paid _Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #35950 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/19/2008 to 08/19/2009 Pass Cancellation)
Cancel Reason: staff error
G/L Code Descri Ac count Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 20.00 DR
The REVENUE account was DEBITED and the CONTROL account was CREDITED on the day of the refund.
Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/19/08 19:27:10 by ARH FEES CHANGED ON CANCELLED ITEMS 20.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
,NET,AMOUNT FROM'CANCELLED'r1TEMS '20;OD=;`
=TOTAL gMOUNT REF,.UNDEDi 20 OD;
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 20.00 Made By REFUND FINAN With Reference
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. N or credit card refunds.
moo q,
Authorized Signature Date Authorized Signature Date
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C CA�.� of s IO,,\ rA AAY�A C
Page 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Lacosse, Tyler Terms
345 Endicott St., Apt 3203 Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8119108 178939 Refund 20.00
Total Is 20.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Lacosse, Tyler Allowed 20
345 Endicott St., Apt 3203
Carmel, IN 46032
In Sum of
20.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members
Dept
1047 178939 4358400 20.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
25 -Sep 2008
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund